Marketization, Managerialism and Welfare State Professionalism
Edited by Tanja Klenk and Emmanuele Pavolini
Chapter 7: ‘Soft governance’ and the knowledge–power bonds in professionalism: case studies from the health care sector in Germany
Over recent years, welfare systems in different countries have introduced new forms of governance to respond to a growing demand for cost-efficiency and quality management of public services. As a common characteristic, governance has moved away from mere hierarchical steering and created new forms that combine market elements, managerialism and network-based governance. The health care sector is a major area of welfare state reform where ‘softer’ modes of governing (Fierlbeck 2014; Flynn 2004; Greer and Vanhercke 2010) have transformed the role of professions, organizations and service users, and more generally, the concept of ‘public’ and the role of the state (Blank and Burau 2013; Pavolini and Guillén 2013; Saltman 2015). The various attempts of implementing new governance in the health care field have provoked scholarly debate over increasing ‘conflict’, but research also highlights ‘hybridization’ between managerial accounts and professional self-regulatory procedures (Kirkpatrick et al. 2009, 2015; Tuohy 2012; Veronesi et al. 2013). Yet ‘hybridization’ only highlights that something new is emerging but does not tell us how this happens, and what the effects on health systems are. In this chapter, we suggest moving beyond the hybridization debate. We introduce an approach that explores the governance changes in health care through the lens of ‘knowledge technologies’ and argue for context-sensitivity in the form of the ‘location’ of knowledge.
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